Right ventricle pacing site selection in children

Abstract

Purpose of study to evaluate the advantage of the interventricular right ventricle (RV) pacing on the RV apex pacing in children with permanent pacemakers. Methods used 112 children (59 males (52.6%)) at the age of 15 to 192 month (mean age 99.6 ± 68.6 month) underwent the pacemaker implantation from 2001 to 2004. 58 children (51.8%) have a postoperative atrio-ventricular block, 54 children (48.2%) have a congenital atrio-ventricular block. 48 patients (42.8%) were paced in VVI mode. 23 patients (20.5%) were paced in VVIR mode. 41 (36.6%) were paced in dual–chamber rate-responsive pacing mode. In 42 patients (37.5%) the ventricle lead was posizioned in right ventricle and screwed in the upper or middle part of the interventricular septum. In the rest of patients (70(62.5%)) ventricular lead was implanted in the RV apex. Results QRS duration was significantly shorter (p>0.05) in patient with interventricular septum pacing system (0.89+0.03 mc) vs. RV apex pacing system (0.14+0.04 mc). There was no paradoxal motion of the interventricular septum. Futhermore in these patients was no signs of the congestive heart failure in long follow-up period. The engection fraction was significantly high (55,8 +10,8 % vs. 34,17+5,3 %) in this group of patients. Conclusion The upper part of the interventricular septum is apreferable site for the permanent right ventricular pacing in children.